What does this research mean for the field?

Potentially inappropriate prescribing of direct oral anticoagulants (DOACs) is highly prevalent (60%) in outpatient settings, primarily due to dosing, administration, and duration errors, and each inappropriate prescribing criterion met doubles the odds of bleeding adverse events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess outpatient prescribing patterns of direct oral anticoagulants (DOACs) for venous thromboembolism and nonvalvular atrial fibrillation, characterize inappropriate use, and identify predictors of adverse events.

March 1, 2017International Journal of General MedicineOpen Access

Utilization and prescribing patterns of direct oral anticoagulants

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Why the study?

Does inappropriate prescribing of direct oral anticoagulants (DOACs) increase the risk of adverse events in adults with nonvalvular atrial fibrillation or venous thromboembolism?

Population

120 adults with nonvalvular atrial fibrillation or venous thromboembolism who received a direct oral…

Design

Cohort

Authors

MWMaegan WhitworthAugusta University Health KHKrystal K. HaaseAmerican College of Clinical Pharmacy DFDavid S. FikeTexas Tech University

Discussion

Member takes

Implication

Inappropriate DOAC prescribing was associated with doubled bleeding odds; hypothesis-generating and should not yet change practice.

Key Points

To assess outpatient prescribing patterns of direct oral anticoagulants (DOACs) for venous thromboembolism and nonvalvular atrial fibrillation, characterize inappropriate use, and identify predictors of adverse events.
Retrospective cohort study analyzing 120 adult patients with nonvalvular atrial fibrillation or venous thromboembolism prescribed a DOAC at family medicine or internal medicine clinics from October 2010 to October 2014.
Evaluated prescribing quality using an adapted medication appropriateness index, with differences assessed via Fisher’s exact test and risk factors for inappropriate use and adverse events modeled with multivariable logistic regression.
At least one inappropriate prescribing criterion was met in 60.0% of patients (72/120), most commonly due to incorrect dosage (33.0%), therapy duration (18.4%), and administration instructions (18.0%).
Adverse events occurred in 22.5% of patients (27/120), and the odds of bleeding nearly doubled for each inappropriate prescribing criterion met (OR = 1.949; 95% CI 1.190–3.190; p = 0.008).
Apixaban was associated with lower odds of inappropriate drug selection compared to other DOACs (OR = 0.088; 95% CI 0.008–0.964; p = 0.047), while overall dosing appropriateness did not differ between clinic specialties.

Structured PICO

Does inappropriate prescribing of direct oral anticoagulants (DOACs) increase the risk of adverse events in adults with nonvalvular atrial fibrillation or venous thromboembolism?

Population

120 adults with nonvalvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) who received a direct oral anticoagulant (DOAC) at family medicine or internal medicine outpatient clinics between October 2010 and October 2014.

Intervention

Direct oral anticoagulants (DOACs), including apixaban, rivaroxaban, and dabigatran

Outcome

DOAC prescribing appropriateness in patients with VTE and NVAF in outpatient clinics

Potentially inappropriate prescribing of DOACs is highly prevalent in outpatient settings and is significantly associated with an increased risk of bleeding adverse events.

Cite This Study

Whitworth et al. (2017) studied this question.

synapsesocial.com/papers/6a1b830447464d53695f409f https://doi.org/10.2147/ijgm.s129235

Topics

Atrial fibrillation Anticoagulation in AF Persistent AF management

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Utilization and prescribing patterns of direct oral anticoagulants

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Utilization and prescribing patterns of direct oral anticoagulants

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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